Carvedilol as therapy in pediatric heart failure: An initial multicenter experience

Objective: The objective was to determine the dosing, efficacy, and side ef fects of the nonselective beta -blocker carvedilol for the management of he art failure in children. Study design: Carvedilol use in addition to standard medical therapy for pe diatric heart failure was reviewed at 6 centers. Results: Children with dilated cardiomyopathy (80%) and congenital heart di sease (20%), age 3 months to 19 years (n = 46), were treated with carvedilo l. The average initial dose was 0.08 mg/kg, uptitrated over a mean of 11.3 weeks to an average maintenance dose of 0.46 mg/kg. After 3 months on carve dilol, there were improvements in modified New York Heart Association class in 67% of patients (P = .0005, chi (2) analysis) and improvement in mean s hortening fraction from 16.2% to 19.0% (P = .005, paired t test). Side effe cts, mainly dizziness, hypotension, and headache, occurred in 54% of patien ts but, were well tolerated. Adverse outcomes (death, cardiac transplantati on, and ventricular-assist device placement) occurred in 30% of patients. Conclusions: Carvedilol as an adjunct to standard therapy for pediatric hea rt failure improves symptoms and left ventricular function. Side effects ar e common but well tolerated. Further prospective study is required to deter mine the effect of carvedilol on survival and to clearly define its role in pediatric heart failure therapy.